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Nationwide Comparison of Operative Outcomes for Robotic, Laparoscopic, and Open Radical Prostatectomy
Mehrdad Alemozaffar1, Martin G Sanda1, Derek Yecies2, Meir J Stampfer3, Stacey A Kenfield3
1Beth Israel Deaconess Medical Center, Boston, MA;2Boston University Medical School, Boston, MA;3Harvard School of Public Health, Boston, MA

Introduction:
Multi-center, community-based evaluations of robot-assisted laparosopic prostatectomy (RALP) and radical retropubic prostatectomy (RRP) are lacking. We sought to evaluate perioperative and oncologic outcomes of RALP and RRP for prostate cancer in a nationwide cohort.
Methods:
The Health Professionals Follow-up Study (HPFS) cohort of 51,529 men was interrogated to evaluate outcomes of men who underwent RALP (N=172) and RRP (N=573) from 2000 to 2009.
Results:
Tumor severity was slightly greater among RRP than RALP patients (Table 1). RRP patients were more likely than RALP to undergo lymphadenectomy (85.4% vs. 46.5%, respectively, p<0.0001), experienced greater mean estimated blood loss (858.9 vs. 206.0 ml, respectively, p<0.0001), were more likely to receive blood transfusions (26.3% vs. 4.7%, respectively, p<0.0001), and had longer mean hospital stays (2.9 vs. 1.9 days, p=0.0001) (Table 2). Oncologic outcomes between RRP and RALP revealed no difference in pathologic stage, gleason score, positive surgical margins, or psa-specific survival (Table 3).

Conclusions:
In this nationwide, community-based cohort RALP was associated with shorter hospital stay and less blood loss than RRP, while yielding similar oncologic outcomes.

Table 1. Preoperative Tumor Characteristics
Total
(N = 745)
RALP
(N = 172)
RRP
(N = 573)
P - Value
Clinical T-StageT168.977.366.50.01 (T1 vs T2+)
T231.022.733.3
T30.100.2
T4000
PSAMedian (ng/dl)5.55.25.70.04
Biopsy Gleason Score<63.51.24.20.04
659.155.960.1
729.937.127.8
8+7.45.97.9

Table 3. Oncologic Outcomes
Total
(N = 745)
RALP
(N = 172)
RRP
(N = 573)
P - Value
Pathologic
T-Stage
T279.379.379.31.0
T320.620.720.6
T40.1400.2
Gleason Score< or =645.237.147.60.07
746.555.743.9
83.93.64.0
9+4.33.64.6
Positive Margins% Patients23.126.123.10.47
Extracapsular Extension% Patients23.119.824.10.29

Table 2. Perioperative Outcomes
Total
(N = 745)
RALP
(N = 172)
RRP
(N = 573)
P - Value
Nerve-SparingBilateral69.471.668.80.82
Unilateral14.714.214.8
None15.914.216.4
Seminal Vesicle Removal% Patients97.197.697.0
Lymph Node Dissection% Patients77.047.085.6<0.0001
Hospital StayMean (days)2.71.92.90.0001
EBLMean (cc)712.8206.0858.9<0.0001
Transfusions% Patients26.34.730.4<0.0001
Mean Units2.02.82.00.54


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